Healthcare Provider Details

I. General information

NPI: 1386490563
Provider Name (Legal Business Name): MARIE ANNE TORCHIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2024
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22601 SAN SEBASTION DR
DELAVAN IL
61734-1677
US

IV. Provider business mailing address

22601 SAN SEBASTION DR
DELAVAN IL
61734-1677
US

V. Phone/Fax

Practice location:
  • Phone: 815-780-0237
  • Fax:
Mailing address:
  • Phone: 815-780-0237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.021985
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: